Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]S...Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.展开更多
Perichondritis of the external ear is referred to inthe literature as pinna perichondritis as well as auricularperichondritis. Pinna （auricular） perichondritis is aninfection involving cartilage and subcutaneous tis...Perichondritis of the external ear is referred to inthe literature as pinna perichondritis as well as auricularperichondritis. Pinna （auricular） perichondritis is aninfection involving cartilage and subcutaneous tissue.The resulting infection produces swelling which canbe severe, and can lead to focal ear necrosis. The termperichondritis may even be considered a misnomer＂as the cartilage is almost always involved.＂[1] Pinna（auricular） perichondritis presents with signs andsymptoms that can include pain。展开更多
Dear editor,Intussusception is the invagination of one portion of the intestines into another, and is the most common form of intestinal obstruction in infants.^([1]) The vast majority of cases of intussusception are ...Dear editor,Intussusception is the invagination of one portion of the intestines into another, and is the most common form of intestinal obstruction in infants.^([1]) The vast majority of cases of intussusception are idiopathic, and are thought to be due to hyperplasia of the lymphoid tissue in the Peyer’s patches of the terminal ileum. The展开更多
INTRODUCTIONEctopic pregnancy occurs at a rate of 1%-2% of all pregnancies, and tends to occur at a higher rate （up to 4%） in patients receiving fertility treatments. Women with ectopic pregnancies are often asympto...INTRODUCTIONEctopic pregnancy occurs at a rate of 1%-2% of all pregnancies, and tends to occur at a higher rate （up to 4%） in patients receiving fertility treatments. Women with ectopic pregnancies are often asymptomatic or may complain of amenorrhea, vaginal spotting, and lower abdominal cramping pain.展开更多
A 27-year-old male presented to the emergency department with acute exercise induced rhabdomyolysis （EIR） following low intensity, high repetition physical activity. It is paramount for the clinician to consider thi...A 27-year-old male presented to the emergency department with acute exercise induced rhabdomyolysis （EIR） following low intensity, high repetition physical activity. It is paramount for the clinician to consider this diagnosis in the differential of the patient presenting with a complaint of musculoskeletal pain. This case highlights the necessity of staying vigilant for a condition that can develop with seemingly minor, repetitive training of a single muscle group, such as in the exercise of calf raises.展开更多
INTRODUCTION The presentation of cardiogenic shock （CS） is usually straightforward, and includes hypotension, absence of hypovolemia, and clinical signs of poor tissue perfusion such as oliguria, cyanosis, cool ext...INTRODUCTION The presentation of cardiogenic shock （CS） is usually straightforward, and includes hypotension, absence of hypovolemia, and clinical signs of poor tissue perfusion such as oliguria, cyanosis, cool extremities and altered mentation. The most common etiology of CS is acute myocardial infarction, Here, we report a case of a 42-year-old male who presented with right flank pain, nausea and vomiting initially thought to be nephrolithiasis, which he had a history of but was ultimately diagnosed with CS due to a type II myocardial infarction. This case illustrates the importance of having a broad differential diagnosis especially when a patient＇s vital signs take a drastic turn since this patient initially resembled someone with nephrolithiasis.展开更多
Phenibut(β-phenyl-γ-aminobutyric acid)is a psychoactive gamma-aminobutyric acid(GABA)analog marketed online as a nutritional and nootropic(cognition enhancing)supplement.Phenibut consumption poses a high risk of pot...Phenibut(β-phenyl-γ-aminobutyric acid)is a psychoactive gamma-aminobutyric acid(GABA)analog marketed online as a nutritional and nootropic(cognition enhancing)supplement.Phenibut consumption poses a high risk of potential abuse.Withdrawal from phenibut mimics benzodiazepine and alcohol withdrawal and can be dangerous.A number of approaches have been described for phenibut withdrawal,including protocols that include baclofen,but for inpatient and outpatient use.Here we describe a 30-year-old male who presented to an emergency department(ED)with insomnia,anxiety and palpitations after he stopped taking phenibut.展开更多
Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppressio...Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppression pattern on EEG. Burst suppression is an EEG waveform pattern of alternating isoelectric suppressions and high voltage bursts, Our patient ultimately made a full neurologic recovery a few days later. While there are two other cases in the literature of bupropion overdose resulting in EEG burst-suppression and loss of brainstem reflexes, we believe this is the only reported adult case complicated by cardiac arrest.展开更多
文摘Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.
文摘Perichondritis of the external ear is referred to inthe literature as pinna perichondritis as well as auricularperichondritis. Pinna （auricular） perichondritis is aninfection involving cartilage and subcutaneous tissue.The resulting infection produces swelling which canbe severe, and can lead to focal ear necrosis. The termperichondritis may even be considered a misnomer＂as the cartilage is almost always involved.＂[1] Pinna（auricular） perichondritis presents with signs andsymptoms that can include pain。
文摘Dear editor,Intussusception is the invagination of one portion of the intestines into another, and is the most common form of intestinal obstruction in infants.^([1]) The vast majority of cases of intussusception are idiopathic, and are thought to be due to hyperplasia of the lymphoid tissue in the Peyer’s patches of the terminal ileum. The
文摘INTRODUCTIONEctopic pregnancy occurs at a rate of 1%-2% of all pregnancies, and tends to occur at a higher rate （up to 4%） in patients receiving fertility treatments. Women with ectopic pregnancies are often asymptomatic or may complain of amenorrhea, vaginal spotting, and lower abdominal cramping pain.
文摘A 27-year-old male presented to the emergency department with acute exercise induced rhabdomyolysis （EIR） following low intensity, high repetition physical activity. It is paramount for the clinician to consider this diagnosis in the differential of the patient presenting with a complaint of musculoskeletal pain. This case highlights the necessity of staying vigilant for a condition that can develop with seemingly minor, repetitive training of a single muscle group, such as in the exercise of calf raises.
文摘INTRODUCTION The presentation of cardiogenic shock （CS） is usually straightforward, and includes hypotension, absence of hypovolemia, and clinical signs of poor tissue perfusion such as oliguria, cyanosis, cool extremities and altered mentation. The most common etiology of CS is acute myocardial infarction, Here, we report a case of a 42-year-old male who presented with right flank pain, nausea and vomiting initially thought to be nephrolithiasis, which he had a history of but was ultimately diagnosed with CS due to a type II myocardial infarction. This case illustrates the importance of having a broad differential diagnosis especially when a patient＇s vital signs take a drastic turn since this patient initially resembled someone with nephrolithiasis.
文摘Phenibut(β-phenyl-γ-aminobutyric acid)is a psychoactive gamma-aminobutyric acid(GABA)analog marketed online as a nutritional and nootropic(cognition enhancing)supplement.Phenibut consumption poses a high risk of potential abuse.Withdrawal from phenibut mimics benzodiazepine and alcohol withdrawal and can be dangerous.A number of approaches have been described for phenibut withdrawal,including protocols that include baclofen,but for inpatient and outpatient use.Here we describe a 30-year-old male who presented to an emergency department(ED)with insomnia,anxiety and palpitations after he stopped taking phenibut.
文摘Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppression pattern on EEG. Burst suppression is an EEG waveform pattern of alternating isoelectric suppressions and high voltage bursts, Our patient ultimately made a full neurologic recovery a few days later. While there are two other cases in the literature of bupropion overdose resulting in EEG burst-suppression and loss of brainstem reflexes, we believe this is the only reported adult case complicated by cardiac arrest.
